NHANES III data show that fewer than 30% of patients who are hypertensive have been treated to the goal blood pressure of less than 140/90 mm Hg. Older patients are more likely to have uncontrolled blood pressure than are younger patients. The SHIELD Study revealed that 41% of people over the age of 65 years and 65% of African Americans over that age have poorly controlled hypertension. Poor blood pressure control also disproportionately causes cardiovascular disease in patient over 60. Systolic blood pressure is the primary predictor in this age group for the development of stroke, congestive heat failure (most common reason for hospitalization in the elderly), renal failure and coronary heart disease. There is even exciting new data showing that control of systolic blood pressure in the elderly reduces the risk for the development of Alzheimer?s dementia. Failure to achieve blood pressure control is determined by three factors: physician practice (behavior), antihypertensive medication efficacy, and adherence to the prescribed medications (patient factors). Our study proposes to develop models that describe each of these factors independently and then develop a model that encompasses all three factors. Specific Aim 1 will identify and quantify differences in physician response to elevated systolic blood pressure in hypertensive patients greater than 60 years of age compared to their younger counterparts. Specific Aim 2 will analyze the differences in responsiveness of systolic blood pressure to treatment regimens using one or more antihypertensive medications. Specific Aim 3 examines adherence and postulates that adherence is the same between younger and older hypertensives. This study is to be conducted using a unique clinical database. Over 7,000 patients with more than 25,000 observations are present in the Mayo Clinic Rochester Hypertension Continuity Clinic Database. This Sybase database is well constructed to answer the important questions posed in Aims 1-3 regarding the management of hypertension. This study will provide significant and generalizable answers to the question of why control rates for systolic hypertension remain low and will provide direction for altering clinical practice to reduce cardiovascular morbidity and mortality among older hypertensives.